Sir: It seems that despite being in a state of battle for the right cause, the Young Doctors Association (YDA) has not achieved its objectives. It is time that the YDA listened to some more experienced doctors for solving their woes. First, the YDA should approach the Supreme Court to know why unlike other government service entrants, trained doctors are not awarded a grade 17 contract (fixed term) upon entering a house job. The practice of awarding different salaries to different categories of professionals of the same educational background is both against the constitution and the civil servants’ Act. There is and never was any point in awarding stipends to qualified professionals, be they house officers or postgraduate residents. Stipends denote studentship and house officers are not students and neither are post-graduate residents. As doctors do not start work in grade 17, they retire at the most in grade 19 or 20 after several decades of service as against bureaucrats who reach grade 21 and 22. It also means that being the bearers of a lower-grade, they get less income and lower status even in later years. Secondly, the YDA needs to realise that doctors cannot go on strike unless three sets of arrangements have been made in advance, and these are: a) Receiving and treating emergencies as nobody else in society can fulfil this duty. b) Observing ‘duty of care’ contract of patients already under their care, which means that OPDs cannot be closed to the patients already under your treatment. c) Adequate notice of strike to your registered patients. YDA office bearers need to understand that the struggle between technocrats on the one side and the bureaucracy and political setup on the other is not new. Be they federal or provincial governments, politicians and bureaucrats know that doctors and allied health workers are more than three times the number of lawyers. Hence they are a much bigger force and perhaps twice more resourceful and powerful in the context of privileged positions. The doctor of today is not produced by government spending Rs100,000 on each one as in the past, but their own families pay for their MBBS; there is no place today for an unpaid doctor as was common in days before. Already the gender disparity in favour of females that was created inadvertently by redefining the merit for MBBS (a result of court decisions and political influence in 1989) has resulted in far fewer male doctors in the last 23 years and hampered evening and remote region healthcare and even the rate of new hospital construction. The Supreme Court can, of course, take suo motu notice and order mandatory award of grade 17 status to house officers and grade 18 status to those with a good record from among postgraduate residents. Otherwise I am afraid the poor are going to suffer by endless YDA strikes. If politicians use force (lauded by the media) to suppress the strike, en masse resignations by doctors may result, which is a more ethical course than remaining on hospital strength and not attending to patients. I hope my advice to the YDA and legal course is adopted rather than a daily strike routine. The Supreme Court can resolve this issue in two hearings. DR M I SHAIKH Islamabad